exams

Exams…
2 weeks of study break- during which we not only needed to cover all there was to know abt Medicine and Surgery, we had Family Medicine as well. It didn’t contribute to our final grade (only Med, Surgery, Obs and Gynae, Psych and Paeds), but it was barring i.e. failing this paper would mean I won’t graduate, regardless of how well I did in med and surg! And all this while I shrugged family med aside, how hard can it be to pass a GP paper right??
The 1st of the study break(18/6), during which all wards were open to all 126 of us, han and I headed to the surgical ward because Mondays were when most patients would be warded to await elective surgery- hernias especially- it was such a scary field, but Mr Lam ran through two hernia examinations with Han and I, spontaneously early one morning, and that made the monster more human. Surprisingly, the wards weren’t swamped. Most were probably preparing for the Written components that would take up our First week (June 1st – 5th) followed by a one week study break for our clinicals, then the clinicals in the 3rd week that would make up 50% of each subject. We had to pass all components, as in pass written, pass clinicals, then only was our grade determined.
By this time, my gastritis was really acting up. I had irritable bowel with colicky pain one day at the epigastric region, the next, suprapubic… and my stomach tolerated so little, I had to resort to downing bottles of honey instead of proper meals!

June 1st Surgery- we had the essay part at 9-11, then MCQ, MEQ between 2-4pm
We had only 2/10 questions on general surgery, 1 on urology,1 on vascular (our incoming professor was a superb vascular surgeon, thus the emphasis), 3 on miscellanous which included specialty surgery- neurosurgery and plastic surgery which I didn’t study, trauma etc, and 3 on ortho (my ortho rotation was spent relaxing, the gravity of the rotation didn’t reach me at that point, plus it was not an easy topic to teach). They asked Colles fracture I think. I prepared by formulating a scheme I was gonna apply to any fractures they asked, and I prayed they wouldn’t ask anything on bone tumors or osteochondritis… the papers became progressively harder, with the MEQ comprising questions on chest pain, which really was a Medicine question. With this day done, we had one day to prepare for medicine…

June 3rd I was particularly afraid of this paper. We had 5 questions in the essay- Pathophysiology of Dengue Fever, Pernicious Anaemia (which is so rare here that I just briefly flicked thru it, half asleep), a drug interaction question with 3 scenarios, and two questions to save us – management of COPD and a question on stroke… sigh… then there was the MEQs where we had to complete each page within 5-7 mins, then place it on the floor, face down, and recall information from previous sheets of paper in the current page, without referring to the papers on the floor! The case unravels and progresses with each paper. And while last year’s batch had a nice pneumonia and pneumothorax, we had renal failure. Yucks! It is such a dry subject, and I never counted it as one of the main topics, the mains being respiratory, cardiovascular, neurology… then the MCQs were a killer. I’ve never circled that many questions to go back and check!

June 5th We had our family medicine papers today… we completed part the OSCE at the end of our respective rotations then today, Friday, we had to complete a written component, and a slideshow OSCE. The OSCE was first, it comprised 10 main questions with stems. There were 3-4 dermatology questions, with one question on causes of red eye. It was really ridiculous… then the written had abt 25 pages! With at least 60% from Paediatrics and OBG and psych. It really boggles me why they decided to separate GP from POP (paeds, obg, psych) and put it in final year.

We had a one week break, but we were informed that the surgical ward was off-limits to us beginning Tuesday. We had to back in college on Tue 10am too, to await any borderline orals (if the committee cant decide if they should bump your 47 to a passing 50, or a normal pass of 57 to an honours 60, etc. Han and I went into the surgical ward at 7am on Monday, we examined a guy with bilateral hernia, a few peripheral vascular disease, and we hung around there till abt 8.30, before moving on to medical wards. Then we got news that one of the surgeons freaked out at how many students were in the surgical wards, and got us barred from the wards effective immediately! Whoa, that was scary, considering the fact that the ward wasn’t that full to begin with, some decided to make the trip to Seberang Jaya hospital, and Taiping Hospital, quite a distance from the island. But we decided to make do with PGH, and we went to the hospital 3 out of the 5 weekdays, and used the rest to study… the pressure was mounting… the following week had us sitting for our Surgical Long Case on Monday (40 mins with the patient,20 mins with the examiner), Surgical OSCE on Tuesday, await our Surgical viva on Wednesday, then Medicine Long Case and OSCE both on either Thursday or Friday, I had mine on Friday thankfully, and in Seberang Jaya.

Surgical Long Case-I was praying to NOT get an ortho case, cause I only found out 3 days before that we could get an ortho case (and Vikki did indeed get one!), I was hoping to get a breast lump, thyroid goitre, but not the ever popular (it makes us 90%of cases!) lower limb- varicose veins and arterial disease. I did a pirouette and a little dance when I got what looked like a thyroid case, the patient spoke English pretty well, but wasn’t very knowledgeable abt her condition, and my examiners were a Prof of Surgery from UM, and some say the Chief Surgeon of Malaysia! Plus I started 10-15 mins late, but my junior-who-was-ushering was not of much help. I still had to be examined at the stipulated time, which meant I only had 25-30 mins with my patient! My usher had to be asked 3 times to let me know how much time I had left! I’ve heard of how ushers in the previous years used to slip the diagnosis to us final meds, and I’m not expecting that from my usher, but ur supposed to be facilitating my exam condition, not acting so stressed and stressing us out even more! Anyways, my examiners grilled me on my history, then they didn’t ask me to present my physical findings but asked me to examine my patient in front of them, and lo and behold, it revealed a thyroglossal cyst! I felt it was went just ok, some of the others had simply goitres, peripheral vascular diseases, breast lumps but others had the rare-in-this-region Ulcerative colitis, lymphoedema (which comprises all of 2 pages in our textbook), weird dysphagia, and some had the RCSI prof of surgery, who’s notorious for failing ppl, and he did, at least 3!
Surgical OSCE went pretty well, except for the thyroid station- the examiner was my long case examiner-so kedekut markah, and the ortho station, we were just told to examine step by step and some ppl got the cruciate ligament tear, I didn’t get that far. But the hernia went pretty well (thanks to Mr Lam’s teaching) – Mr Kingston examined-the hernia was huge, I was surprised it was reducible!, and the abdomen has a huge splenomegaly, and Prof Kevin’s station was an arterial disease patient. We were in PMC, but while those in PGH got the same cases, their examiners were pretty scary.
We got the news that 7 ppl failed-with no hope of being saved, and 7 ppl went for viva-out of which only 2 were saved. So that was 12 ppl who weren’t graduating!

Medicine- I was hoping to get a simple asthma, or acute coronary syndrome, or heart failure, or diabetes. So I was concentrating one those major topics, after all common things are common. I saw the rheumatology part, but I had too much to cover, so I skipped it. We had to prepare for osce too, so short cases as well- spot diagnosis- rheumatoid hands, malar rash, scleroderma, then neurology resp, cardio and abdomen all had a station each-so thalassaemia… thankfully I had Thursday to study, dunno how I would have done it otherwise. Friday morning I went to church as I had done quite a few times throughout the exam.. only God could calm my nerves. I was afraid of getting a weird long case, and not being able to say anything at all! We had 1 hr with the patient and 20 mins with the examiners. I got a rheumatoid arthritis case, of all cases!! But I got Dr Yeow- who’s one of the classiest and nicest physician in PMC and an external examiner. Dr yeow wanted me to give SLE as a differential but she lead me to it, and questioned me on it. The examination of hands was so patchy in my head. After all most of the time we did spot diagnosis, not much on test of function etc. sigh… but the osce was ok… I started off with neurology with Prof Richard- the guy had a homonymous hemianopia (luckily zaza told me the day b4, I was expecting only facial nerva palsy, bulbar and pseudobulbar, then parkinson’s, cerebellar the basics;-)), but they put another patient in that 7 min station, a polio patient!! Since the mass vaccination of babies, polio was such a rarity… but Prof Richard as usual made it a pleasant experience. Then I moved to spot diagnosis, initially I missed the first patient’s thyroid goitre, but Dr Ang of SJH wanted pretty specific answers, and the next was a lady with RA, he also prodded till he got the answers he wanted, the invigilators told me I did a good job, but in that state, how to believe anyone? I’d lose focus. The next station was cardio… I was afraid of this, so I practised a lot… I expected to do a running commentary, it is pretty hard to garner marks if we only present at the end, we might run out of time and not get any marks at all! But he told me to proceed, while he stood by the door chatting with one doctor… sigh… I heard two murmurs but had trouble placing those two murmurs… we always had single murmurs and thus we prepared for it… then I had to go stand in front of the examiner, at the door and he asked ‘what’s your diagnosis’… I panicked but just threw Aortic regurgitation to him. He seemed happy, then I mentioned an Austin Flint murmur, but I think with the fan blowing at him he didn’t hear. He was nagging me too, I later learnt he nagged everyone! Ehhe but later when he continued to question me, he said I was doing well, and to relax. I took a while to mention Austin flint again, cause I didn’t know he didn’t hear me, and I didn’t wanna anger him more by repeating myself and sounding stupid… but that was really one of the weirdest examiner… hehe the respiratory case was C-R-A-Z-Y! I had to examine the front of his chest, when I’m used to zero-ing on the back, thus I kept mixing up my rights and lefts, and I’ve always thought ppl who did that was pretty dense! But I think I did ok cause I detected the hyperresonance of the left side due to overcompensation cause his right lung was missing! The scary examiner showed me an X-Ray with a missing right lung, which I was only able to pick up as I was walking away.. hehe really one of those ‘look at the big picture moments!
My very final station was with Dr Letch from Taiping, who is the nicest head of department ever…. He’s so humble and kind. But he was pretty serious in the exam… I had a patient with many signs of chronic liver disease! With spider naevi and all!
I emerged from that exam feeling pretty shaken, but I learnt that compared to the rest, I did quite ok, I got to x-ray, got the mean cardiologist’s praise,…
And I was done with final exams!!!